Pseudomembraneous colitis cephalosporins

Therapy with cephalosporins may result in a bacterial or fungal superinfection. Diarrhea may be an indication of pseudomembranous colitis, which is one type of bacterial superinfection. See Chapter 7 for a discussion of bacterial and fungal superinfections and pseudomembranous colitis. 

Pseudomembranous colitis Pseudomembranous colitis occurs with the use of cephalosporins (and other broad spectrum antibiotics) therefore, consider its diagnosis in patients who develop diarrhea with antibiotic use. 

Like penicillins, cephalosporins alter the normal microflora of the intestinal tract and can canse anorexia, nausea, vomiting, and diarrhea. In some cases the diarrhea can become severe enough to warrant discontinuation of the drug. Antibiotic-associated pseudomembranous colitis due to C. dijficile can also occur with the cephalosporins. This condition should be considered in the differential diagnosis of diarrhea associated with cephalosporin use. 

Pseudomembranous colitis was known before the introduction of antimicrobial agents and can still occur without previous antibiotic use, for example after antineoplastic chemotherapy (125) or even spontaneously. However, the number of cases has increased dramatically since antibiotics began to be used (126). Patients treated with lincomycin or clindamycin, cephalosporins, penicillinase-resistant penicillins, or combinations of several antibiotics... 

The appearance of pseudomembranous colitis in clusters of patients (143-146) may explain the wide variation in occurrence, and suggests that the disease may result from cross-contamination among patients rendered susceptible by antibiotic treatment. This is especially true for epidemic outbreaks in hospitals, where the disease may be considered a nosocomial infection favored by serious illness, frequent and prolonged use of broad-spectrum antibiotics (especially cephalosporins), and poor compliance with the rules of hospital hygiene (147). In such an epidemic, a variable proportion of... 

Although many infections with gram-positive cocci respond to clindamycin, the high incidence of diarrhea and the occurrence of pseudomembranous colitis limit its use to infections where it is clearly superior to other agents. Clindamycin is particularly valuable for anaerobic infections, especially those due to B. fragiUs. Clindamycin is not predictably useful for the treatment of bacterial brain abscesses metronidazole, in combination with penicillin or a third-generation cephalosporin, is preferred. 

Aside from mild or severe allergic reaction, the most commonly experienced cephalosporin toxicities are mild and temporary nausea, vomiting, and diarrhea associated with disturbance of the normal flora. Rarely, a life-threatening pseudomembranous colitis diarrhea associated with the opportunistic and toxin-producing anaerobic pathogen, Clostridium difficile, can be experienced. Rare blood dyscrasias, which can even include aplastic anemia, also are seen. Certain structural types (details below) are associated with prolonged bleeding times and an antabuse-like acute alcohol intolerance. 

Gastrointestinal upsets, nausea, and vomiting have been observed with virtually all beta-lactam antibiotics, both oral and parenteral. Even when comparing analogous applications and doses, no particular risk can be clearly ascribed to a given compound. Acute hemorrhagic colitis without pseudomembrane formation has been described after treatment with various penicillins and cephalosporins (SEDA-21, 261). 

Acute hemorrhagic colitis without pseudomembranes has been reported after oral cefuroxime (SEDA 21, 261). In mice, some cephalosporins accelerated gastric emptying, in some instances even more effectively than erythromycin or metoclopramide (93). The relevance of this to the gastrointestinal adverse effects of cephalosporins, such as nausea and vomiting, is uncertain. 

---